Is it just heartburn, or is your gallbladder secretly staging a coup? In this week’s HT Health Talk — the reader-centric initiative by Hindustan Times — we tapped Dr Anupama N K, senior consultant, medical gastroenterology, Aster CMI Hospital, Bengaluru, to clear up the confusion around gallstones, digestion, and life post-surgery . Also read | What happens when the gallbladder is removed? Physician Dr Kunal Sood explains
Acid reflux usually happens when stomach acid flows back into the food pipe, causing a burning sensation behind the breastbone, sour taste, burping or discomfort that may worsen after meals or when lying down. A gallbladder attack, usually caused by a gallstone blocking the bile duct, typically causes sudden or steady pain in the upper right or upper middle abdomen. The pain may occur after a heavy or fatty meal and can last for several hours. It may also spread to the back or right shoulder. Unlike reflux, gallbladder pain is often severe and persistent and may be accompanied by nausea or vomiting. Fever, jaundice or worsening pain can indicate complications and require prompt medical evaluation. Ultrasound is generally the first and most useful test for detecting gallstones, but a normal scan does not always rule out gallbladder disease. If symptoms strongly suggest gallstones, a doctor may recommend additional testing based on the suspected problem. Magnetic resonance cholangiopancreatography, or MRCP, can provide detailed images of the bile ducts and identify stones that may not be visible on routine ultrasound. Endoscopic ultrasound can detect very small stones or sludge with greater sensitivity. Blood tests, including liver function tests and pancreatic enzymes, can help identify bile duct obstruction or pancreatitis, although they cannot confirm gallstones on their own. In selected patients, a HIDA scan may be used to assess gallbladder function and detect problems such as poor emptying. In selected cases, certain medications, such as ursodeoxycholic acid (ursodiol), can gradually dissolve cholesterol-based gallstones. However, this treatment is not suitable for everyone and works best for carefully selected patients with specific types of stones and a functioning gallbladder. Treatment can take months or even years, and gallstones may return after the medication is stopped. It is generally less effective than surgery for people who have recurrent, symptomatic gallstones. Procedures such as shock-wave lithotripsy may also be considered in highly selected situations, but they are not routine treatments. There are also no reliable home remedies, special drinks or ‘gallbladder cleanses’ proven to dissolve gallstones. Anyone considering non-surgical treatment should discuss the risks, benefits and likelihood of recurrence with a specialist. The main difference is that bile is no longer stored and concentrated in the gallbladder; instead, it flows more continuously into the intestine. Some people notice temporary changes such as looser stools, increased bowel movements, gas or bloating, particularly during the first few weeks after surgery. For many patients, digestion gradually settles as the body adapts. There is usually no need for lifelong dietary restrictions, and most people eventually return to a normal, balanced diet. Eating smaller meals initially and limiting very fatty or greasy foods can make the adjustment easier. Persistent digestive symptoms, however, should be discussed with a doctor rather than assumed to be a normal consequence of surgery. Also read | ‘Diarrhoea after gallbladder removal is more common than people realise’: Gastroenterologist suggest what might help Yes. A small proportion of people develop persistent diarrhoea, urgency, bloating or abdominal discomfort after gallbladder removal. One possible reason is bile acid diarrhoea, where the continuous flow of bile into the intestine irritates the colon and leads to frequent, watery stools. Treatment depends on the underlying cause. Doctors may initially recommend smaller meals, gradually increasing fibre and reducing very fatty foods. If bile acid diarrhoea is suspected, medicines known as bile acid sequestrants, such as cholestyramine, may be prescribed. Persistent bloating can have other causes, including food intolerance, irritable bowel syndrome or changes unrelated to surgery, so evaluation is important. Ongoing diarrhoea, weight loss, blood in stools, severe pain or other concerning symptoms require medical assessment. Gallbladder attacks often occur when a gallstone temporarily blocks the flow of bile, and symptoms may become noticeable after eating a large or high-fat meal. Foods that commonly trigger symptoms include fried foods, fatty meats, processed foods, rich gravies, full-fat dairy products, pastries and other meals high in saturated or total fat. However, triggers vary between individuals, and food does not directly cause an existing gallstone to disappear or move safely. People with symptomatic gallstones may benefit from smaller, more frequent meals and a balanced diet containing vegetables, fruits, whole grains and lean protein. Anyone experiencing repeated attacks should seek medical advice rather than relying only on dietary restriction. Her expertise spans GI motility and neurogastroenterology, luminal endoscopy, functional bowel disorders, liver diseases, constipation and food allergy. She has publications in national and international journals and is a member of INASL, ISG, ESNM and ANMA.
Dr Anupama N K is senior consultant, medical gastroenterology, Aster CMI Hospital, Bengaluru, with over 12 years of experience. Because the liver continues to produce bile, most people can digest food normally after gallbladder removal,. Because they can increase the risk of gallstone formation, crash diets and rapid weight loss should also be avoided.
